an ethical problem

[wolewyck]

We rent a car a lot from a certain national company. There's one guy who nearly always does the drop-offs and pick-ups. He's older, very overweight, is generally late, and always seems to have a hard time remembering where our house is, although he's been here a lot (we are regular renters). Then one morning he mentions how tired he is, how he hasn't yet had his morning coffee, and all of a sudden I get the "duh!" light going off. So I ask if he snores, and he gets where I'm going immediately-- he says yes, he does, and tells me that he has apnea. He was diagnosed some years ago but couldn't get used to the CPAP and so gave it up. I asked if he has medical insurance-- no. I'm certain he earns very little. He mentioned (in a totally separate conversation) that his hours are limited to just below the level at which the company would have to provide him benefits. I've had enough conversations with this guy over the years to know that he's supporting his family with his work.

So here's a guy who is scraping by-- and at the same time has a job that involves driving other people around. He doesn't have the inclination (or, in all probability, the means) to get treatment. I have not seen signs of unsafe driving when I've been in the car with him. At the same time, we know what apnea does to the risk of fatal car accidents, as recognized by NTSB's recommendations for screening of commercial drivers.

So what do I do? Nothing? Don't get in a car with him? Tattle to the rental car company? Aarggh!!

[cflame1]

encourage him to try again.

[Slinky]

Suggest sleeping in a recliner. Suggest where he may find assistance w/getting an APAP and how that can be used to auto titrate. Explain how THE MASK is THE KEY to successful CPAP therapy. Suggest trying to sleep w/one of those sports mouthpieces. Tell him how much better you are feeling and doing since using CPAP therapy.

[islandboy5150]

There's no ethics issue here in my opinion. Unless he did something that put you in imminent danger, then you would have something to complain about (like running a red light). Otherwise, I'd say don't go running to his employer, especially to tell of supposed medical problems this guy may or may not have. You aren't his doctor nor his employer. It's the employer's responsibility under state law to ensure their drivers are medically qualified to drive others around. If it bothers you to get in a car with him, then maybe take a cab. That's my take on this, anyway.

[GumbyCT]

Ask if he gets on the internet. Tell him about this forum. Offer to help. Esp. if you have a mask or machine you don't need.

[rested gal]

I definitely would not tattle on him to the rental car agency.

All the suggestions I've read above are excellent.

[rosiefrosie]

I would continue to talk with him about it. Maybe tell him your story with apnea, what untreated sleep apnea can do to a body and about all the different types of machines and masks. I really would have a hard time getting in a car with him driving. How is his driving?

rosie

[SleepyT]

I definitely would not tattle on him to the rental car agency.

All the suggestions I've read above are excellent.

I agree. You might also ask if he has high blood pressure....and let him know he is at risk for other complications....

[wolewyck]

Yeah, once I realized he had apnea, I did try to have exactly this kind of discussion with him--gently, so as to not be all "in-your-face" about it. Mentioned my own story and improvement, mentioned the risks of nasty complications, etc. But, he seemed pretty committed/determined not to seek treatment, unfortunately. He said that masks made him seriously claustrophobic-- although that's something we could perhaps try to discuss more, it was kind of a "no way" reaction, if you know what I mean. I mentioned surgery, which he hadn't realized might be an option--but of course lacking insurance, it's not a realistic one--and his immediate response was that he would never, ever go under the knife unless his life was in imminent danger. Pointed out the dangers of surgeons who may (in his words) have gone out partying all night or be cranky and then 'take it out' on the patient in front of them. Anyway, while I may disagree with some of what he said, there's certainly the possibility of surgeons being up all night and making mistakes--or heck, being human and making mistakes, and surgery always has risks anyway, and isn't always successful. So... yeah. If he seems at all open to it, I could definitely make the offer of an extra mask for him to try, since I do have a couple, but if he doesn't have a machine, then that's a dead end.

Point is, yes, it's worthwhile continuing the conversation, and next time, I'll even give him a little card with the URL of this forum on it (of course, I don't even know if he has internet access)... but I think that realistically the probability of me succeeding in persuading him to give it another go is low.

[kteague]

Since you seem to be on reasonably comfortable terms with him, maybe you could discuss (compassionately not threateningly) if he is aware that untreated apnea could cost him his license (and livlihood) and that his untreated apnea puts both he and his passengers at greater risk. He may need to hear the hard truth that this is bigger than how he feels about it, tempered by assuring him that you are open to walking alongside him as he does what he needs to do.

[DoriC]

I'm wondering how does one who suspects OSA get a sleep study and purchase equipment with no insurance and supporting a family on a minimal salary? How could you purchase a used machine and mask without an RX(on Craigs List?) Would a primary care Dr provide an RX without a sleep study? I'm sure there's a way and even some people here have probably done it but I'm wondering what steps need to be taken?

[sister]

Maybe he could apply for Medicaid? I think this is health insurance for people of low income.

[wolewyck]

Ditto for DoriC's questions-- if answers exist, let me know 'cause I'd love to pass them on...

Here's another idea for something I could do about the bigger situation-- maybe I could anonymously write to the corporate (not local) office of the car company, educate them about apnea generally and this guy specifically (not by location or name of course), and strongly suggest that they: (a) think about screening their drivers for apnea, and (b) provide freakin' health insurance to them so that they can get treatment-- especially for conditions that pose risk to customers/potential liability risk to the company, eh?

[GumbyCT]

Ditto for DoriC's questions-- if answers exist, let me know 'cause I'd love to pass them on...

Here's another idea for something I could do about the bigger situation-- maybe I could anonymously write to the corporate (not local) office of the car company, educate them about apnea generally and this guy specifically (not by location or name of course), and strongly suggest that they: (a) think about screening their drivers for apnea, and (b) provide freakin' health insurance to them so that they can get treatment-- especially for conditions that pose risk to customers/potential liability risk to the company, eh?

Ouch... not so sure that wouldn't screw him. Give him another chance. Is there a support group in your area you could invite him to?

EDIT: Invite him to this - http://doctorstevenpark.com/expert-inte ... leep-apnea

[rested gal]

Here's another idea for something I could do about the bigger situation-- maybe I could anonymously write to the corporate (not local) office of the car company, educate them about apnea generally and this guy specifically (not by location or name of course), and strongly suggest that they: (a) think about screening their drivers for apnea, and (b) provide freakin' health insurance to them so that they can get treatment-- especially for conditions that pose risk to customers/potential liability risk to the company, eh?

I don't think I'd do that. Somehow, someway, it might backfire and end up getting him in trouble.